Orthoses are external supports (braces) for the body, which are custom fitted and/or custom fabricated for the specific needs of the patient. The typical process for creating a brace for a patient includes patient assessment, formulation of a treatment plan for the patient, implementation of the treatment plan, follow-up, and practice management.
The procedures traditionally used to produce a knee orthosis (KO) only involve the use of measurements or creating a negative cast (which is wrapped on the patient). When the brace is produced from a cast, some manufacturers instruct practitioners to position the patient's knee in full extension without corrective forces applied during the procedure. The manufacturer then modifies the positive cast (by filling the negative cast with plaster—the hardened plaster results in the negative cast) to provide the corrective forces. The prior art has soft anterior shells, very narrow hard shells, or larger shells made from non-corrective casts, and do not extend proximally over the tibial condyles, not having corrective forces applied during casting or measuring.
The prior art procedures traditionally used to produce a knee ankle foot orthosis (KAFO) involve different procedures to cast for the KAFO, which may include tri-planar design in the foot and ankle, but only bi-planar design at the knee. Those procedures control knee movement in the coronal (frontal—for viewing varus and valgus of the knee) and saggital (side—for viewing flexion and extension of the knee) planes only. Those traditional procedures do not address deformities of the knee in the transverse plane (rotation—internal and external movement), which are addressed by the invention disclosed herein. When patients have posterolateral corner (PLC) injuries or deficits, all three planes are involved. Until now the knee has only been supported in two planes simultaneously. To achieve optimal results, the knee must be controlled in all three planes.
Rotating the foot to try and produce external rotation only slightly effects the knee. It is also difficult or not possible to achieve neutral or external foot rotation with some patients with moderate to severe neuroskeletal deficits or deformities. This invention is unique in the process of achieving the tri-planar support desired to produce an orthosis that controls posterolateral movement of the knee. Traditionally, the procedures to produce a negative cast for a KAFO involves the cast being applied to the patient, then corrective three point pressures are applied to the proximal medial thigh (directing pressures laterally), to the lateral knee or proximal lateral calf (to direct pressures medially), and a medial pressure is applied at the distal calf (directing pressure laterally). These pressures are applied with the patient's knee straight or slightly flexed with the foot having no correction or correction made after the upper section was cast. This traditional method does not produce the rotational alignment required to achieve the maximum benefit to the patient. Even a cast taken with the external rotary deficiency (ERD) corrections to the foot does not affect the rotation of the knee adequately. The present invention disclosed herein is unique in the process of achieving the tri-planar support desired to produce an orthosis that controls posterolateral movement of the knee and restore the screw home motion of a normal knee.